Naturopathy Work Group Report to the Minnesota Legislature 2009 Minnesota Department of Health March 2009 Commissioner’s Office 625 Robert St. N. P.O. Box 64975 St. Paul, MN 55164-0975 (651) 201-4989 www.health.state.mn.us Naturopathy Work Group March 2009 For more information, contact: Tom Hiendlmayr Health Occupations Program Minnesota Department of Health 85 East Seventh Place, Suite 220 P.O. Box 64882 Saint Paul, MN 55164-0882 Phone: (651) 201-3721 Fax: (651) 201-3839 TDD: (651) 201-5797 As requested by Minnesota Statute 3.197: This report cost approximately $33,000 to prepare, including staff time, printing and mailing expenses. Upon request, this material will be made available in an alternative format such as large print, Braille or cassette tape. Printed on recycled paper. NaturNaturopathyopathy Work Group Report March 2009 Table of Contents INTRODUCTION and EXECUTIVE SUMMARY 2 A. The Community of Naturopathic Practitioners 2 B. Formation and Appointment of Naturopathy Work Group Members 2 C. Naturopathy Work Group Outcomes 3 ISSUE 1: Appropriate Level of Regulation for Naturopathic Medical Doctors or Physicians with a Postgraduate Degree in Naturopathic Medicine 6 ISSUE 2: Definitions that Ensure the Distinction between the Practice of Naturopathic Medicine and the Practice of Traditional Naturopathy 9 ISSUE 3: Level of Education and Training for Postgraduate Degree Level of Practice of Naturopathic Medicine and the Appropriate Credentialing of Educational Programs 11 ISSUE 4: Exclusive Scope of Practice for Naturopathic Medical Doctors, Consistent with Training and Assuring Continued Practice of All Complementary and Alternative Health Practices, Including Naturopathy, Currently Practiced under Minn. Stat. Ch.146A 13 ISSUE 5: Appropriate Regulatory Authority 15 ISSUE 6: Other Regulatory Requirements for Naturopathic Medicine 16 Appendices A. To the Executive Summary: 1. Legislation Establishing the Naturopathy Work Group A-1 2. Table of Naturopathy Work Group Members and Alternates A-12 3. Naturopathy Work Group Meeting Dates and Agenda Topics A-14 B. Amendments Requested by Traditional Naturopath Work Group Members A-20 C. MNANP Recommendations for the Naturopathy Work Group, November 18, 2008 A-21 D. MDH Proposed Statement of Legislative Intent and Revisions Suggested by Traditional Naturopath Work Group Members and MNACAP Representatives A-25 Introduction aaandand Executive Summary In Minnesota Session Laws 2008, Chapter 348, sections 1 to 11 and 14, the Legislature enacted Minnesota Statutes Chapter 147E providing for registration of naturopathic doctors, establishing an advisory council to the Board of Medical Practice and setting an effective date of July 1, 2009. In section 12 of Chapter 348, the Legislature directed the Commissioner of Health to convene a work group to develop recommendations and proposed legislation on regulating naturopathic practitioners who have postgraduate degrees in naturopathic medicine. The recommendations were to address six issues and to ensure the continued practice of traditional naturopathy by traditional naturopaths under Minnesota Statutes, Chapter 146A. Section 12 also designated membership and operation of the work group. See Appendix A-1. This document is the Commissioner’s report of the Naturopathy Work Group findings and outcomes. The Community of Naturopathic Practitioners There are many interest/stakeholder groups in the traditional naturopathy community concerned with the issues related to the registration of naturopathic medicine practitioners who have postgraduate degrees in naturopathic medicine.1 Minnesota Department of Health (MDH) staff identified the following distinct interests and organizations: In support of the registration statute representing doctors of naturopathic medicine: ▫ Minnesota Association of Naturopathic Physicians (MNANP) In opposition to one, several or all of the provisions in Minn. Stat. Ch. 147E representing the traditional naturopathy community: ▫ Coalition for Natural Health ▫ Minnesota Natural Health Coalition ▫ Minnesota Advocates for Complementary & Alternative Practices (MNACAP) ▫ National Health Freedom Action/Coalition (NHFA/NHFC) ▫ Minnesota Natural Health - Legal Reform Project (MNHLRP) ▫ Natural Health Practitioners of Minnesota Formation of Naturopathy Work Group and Appointment of Members Commissioner appointment of members to the Work Group representing naturopathic physicians, traditional naturopaths, the associations for medicine, chiropractic and acupuncture followed a self-selection, nomination process. The result of this process was that MNACAP and MNHLRP representatives were elected as alternate Work Group members, and as such did not have a direct voice in Work Group meetings. All Work Group members, alternates and their organizational affiliations are listed in Appendix A-2. The Naturopathy Work Group was 1 In Minnesota Session Laws 2008, Chapter 348, sections 1 to 12 and 14, naturopathic practitioners who have postgraduate degrees in naturopathic medicine are variously referred to as “naturopathic doctor,” “naturopathic physician,” “naturopathic medical doctor,” “doctor of naturopathic medicine” and “registered naturopathic doctor.” Throughout this report, naturopathic practitioners who have postgraduate degrees in naturopathic medicine who are to be registered under Minn. Stat. Ch. 147E will be referred to as “doctors of naturopathic medicine” or as “representatives of MNANP” (Minnesota Association of Naturopathic Physicians.) 2 organized in July, 2008, and met seven times from August through December 2008. Three “break-out” meetings were held, two with traditional naturopath members and alternates, and one with doctors of naturopathic medicine and alternates. Appendix A-3 contains all meeting date announcements and agendas. MNACAP, MNHLRP and the other traditional naturopath organizations did not agree in their views and approaches to the issues concerning future regulation of doctors of naturopathic medicine. The differences made communications and efforts to find consensus among traditional naturopaths challenging. However, Department staff communicated with MNACAP, MNHLRP and most other Work Group members apart from scheduled meetings so that all views and concerns could be included in discussion of issues, findings and consideration of recommendations and proposed legislation for this report. Naturopathy Work Group Outcomes The Naturopathy Work Group members agreed that: 1. Traditional naturopathy practitioners support registration of Doctors of Naturopathic Medicine and their ability to practice according to their education and training in naturopathic medicine; and 2. Doctors of Naturopathic Medicine support continued practice and practices of traditional naturopathy by providers under Minn. Stat. Ch. 146A. Regarding the issues the Legislature directed the Naturopathy Work Group to address, the Commissioner reports the following outcomes: 1. Work Group members representing traditional naturopathy practitioners offered “that Minn. Stat. Ch. 147E should not be amended in 2009 Legislative Session if the working group members agreed to not oppose specific amendments agreed upon by all members and brought forth in the 2010 session…the exact language of agreed upon amendments as follows:” a. Proposed Amendment #1. Add a new clause to Minn. Stat. section 147E.01, subdivision 10, as follows: [147E.01] DEFINITIONS. Subd. 10. Naturopathic medicine. "Naturopathic medicine" means a system of primary health care for the prevention, assessment, and treatment of human health conditions, injuries, and diseases that uses: (1) services, procedures, and treatments as described in section 147E.05; and (2) natural health procedures and treatments in section 146A.01, subdivision 4. (3) section 2. [147E.05] Scope of Practice (sic) includes a number of complementary and alternative health care practices including but not limited to naturopathy that do not require registration and are also provided under chapter 146A. 3 b. Proposed Amendment #2. Add clarifying language to Minn. Stat. section 147E.10, subdivision 1, as follows: [147E.10] PROTECTED TITLES. Subdivision 1. Designation. (a) No individual may use the title “registered naturopathic doctor,” “naturopathic doctor,” “doctor of naturopathic medicine,” or use, in connection with the individual's name, the letters “R.N.D.” or “N.M.D.,” or any other titles, words, letters, abbreviations, or insignia indicating or implying that the individual is a registered naturopathic doctor unless the individual has been registered as a registered naturopathic doctor according to this chapter. The use of the title and terms “naturopathy”, “naturopath” or any other title or term not otherwise prohibited by law shall not be restricted, protected, or regulated under this chapter. c. Proposed Amendment #3. Add a new definition for complementary and alternative health care practices to Minn. Stat. section 147E.01, as follows: [147E.01] DEFINITIONS. Subd. 12. Complementary and Alternative Health Care Practices has the same meaning as defined in MN Stat Chapter 146A, Subd. 4. 2. The Work Group member representing the Office of Complementary and Alternative Health Care Practice (OCAP) supported the position of the Work Group members representing traditional naturopathy practitioners expressing the view that the amendments were a reasonable request for assurances that Minn. Stat. Ch. 146A practitioners would be unaffected by the registration and practice of doctors of naturopathic medicine, that